Comparison of short-term surgical outcomes between totally laparoscopic and laparoscopic-assisted distal gastrectomy for gastric cancer: a 10-y single-center experience with meta-analysis
Comparison of short-term surgical outcomes between totally laparoscopic and laparoscopic-assisted distal gastrectomy for gastric cancer: a 10-y single-center experience with meta-analysis
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DOI：
10.1016/j.jss.2014.10.020
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发表时间：
2015-04-01
影响因子：
2.2
通讯作者：
Huang, Chao-Jie
中科院分区：
文献类型：
--
作者：
Chen, Ke;Mou, Yi-Ping;Huang, Chao-Jie
背景：腹腔镜辅助远端胃切除术（LADG）和全腹腔镜远端胃切除术（TLDG）是腹腔镜胃癌切除术中常用的两种方法。本研究旨在比较这两种方法的短期手术效果。方法：回顾2004年10月至2014年2月间前瞻性维护的胃癌数据库，纳入115例LADG患者和198例TLDG患者。比较两组患者的临床特点及围手术期临床结果。此外，还进行了系统回顾和荟萃分析。结果：两组平均手术时间、出血量、淋巴结清扫数相近。两组在首次放屁时间、重新开始口服摄入时间、术后住院时间和术后并发症方面无显著差异。荟萃分析显示，两组在手术时间、手术切缘、首次排气时间、住院时间、死亡率、总死亡率和吻合口相关并发症方面无显著差异。而TLDG组术中出血量较低（加权平均差值为21.50 mL， 95%可信区间为9.79 ~ 33.22,P < 0.01），淋巴结清扫数较高（加权平均差值为-1.56,95%可信区间为-2.69 ~ -0.44,P < 0.01）。结论：与LADG相比，TLDG是安全可行的。然而，根据我们的研究，很难确定TLDG相对于LADG的临床优势。因此，手术入路的选择主要取决于患者的病情和患者或外科医生的偏好。(C) 2015爱思唯尔公司版权所有。
Background: Laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) are two commonly used methods of laparoscopic gastrectomy for gastric cancer. This study aimed to compare the short-term surgical outcomes of these two methods.Methods: A prospectively maintained gastric cancer database between October 2004 and February 2014 was reviewed and 115 patients underwent LADG and 198 patients underwent TLDG were included. The clinical characteristics and perioperative clinical outcomes of two groups were compared. Moreover, a systematic review and meta-analysis were conducted.Results: The mean operation time and blood loss were similar in two groups, as was the number of retrieved lymph nodes. There was no significant difference in time to first flatus, the time to restart oral intake, the length of the hospital stay after surgery, and postoperative complications. The meta-analysis revealed no significant differences in the operative time, surgical margin, time to first flatus, length of hospital stay, mortality, overall, and anastomosis-related complications among the groups. However, the intraoperative blood loss was lower in TLDG (weighted mean difference = 21.50 mL; 95% confidence interval: 9.79-33.22; P < 0.01), and number of retrieved lymph nodes was higher in TLDG (weighted mean difference = -1.56; 95% confidence interval: -2.69 to -0.44; P < 0.01).Conclusions: TLDG is safe and feasible compared with LADG. However, it is difficult to identify the clinical advantages of TLDG over LADG based on our study. Thus, the choice of surgical approach mainly depends on the patient conditions and the preference of the patients or surgeons. (C) 2015 Elsevier Inc. All rights reserved.